奖励相关预测因子对快感缺失青少年接受行为激活治疗后的症状变化:一种多模态方法。

Reward-related predictors of symptom change in behavioral activation therapy for anhedonic adolescents: a multimodal approach.

机构信息

Harvard Medical School, Boston, MA, USA.

McLean Hospital, Belmont, MA, USA.

出版信息

Neuropsychopharmacology. 2023 Mar;48(4):623-632. doi: 10.1038/s41386-022-01481-4. Epub 2022 Oct 28.

Abstract

Anhedonia is a cardinal characteristic of depression which predicts worse treatment outcome and is among the most common residual symptoms following treatment. Behavioral Activation (BA) has been shown to be an effective treatment for depressed adults, and more recently, depressed adolescents. Given its emphasis on systematically and gradually increasing exposure to and engagement with rewarding activities and experiences, BA may be a particularly effective intervention for adolescents experiencing anhedonia and associated reward system dysfunction. In the present study, anhedonic adolescents (AA; n = 39) received 12 weekly sessions of BA and completed a multimodal (i.e., neural, behavioral, and self-report [ecological momentary assessment]) assessment of reward function at pre-treatment and post-treatment (as well as weekly self-report assessments of anhedonia). Typically developing adolescents (TDA; n = 41) completed the same measures at corresponding timepoints. Multilevel models tested pre-treatment reward-related predictors of anhedonia improvement, as well as change in reward measures over the course of BA. Analyses revealed significant reductions in anhedonia following BA treatment. Enhanced pre-treatment neural (striatal) reward responsiveness predicted greater anhedonia improvement. In contrast, baseline self-report and behavioral reward measures did not predict treatment outcome. A group x time interaction revealed greater increases in both reward- and loss-related neural responsiveness among AA relative to TDA adolescents. Consistent with a capitalization (rather than compensatory) model, pre-treatment neural - but not self-report or behavioral - measures of relatively enhanced reward responsiveness predicted better BA outcome. In addition to alleviating anhedonia, successful BA may also increase neural sensitivity to affectively salient (e.g., reward- and loss-related) stimuli among anhedonic youth.

摘要

快感缺失是抑郁症的一个主要特征,它预示着治疗效果更差,是治疗后最常见的残留症状之一。行为激活(BA)已被证明是治疗成年抑郁症患者的有效方法,最近也被证明是治疗青少年抑郁症患者的有效方法。鉴于其强调系统地和逐步地增加对奖励性活动和体验的接触和参与,BA 可能是治疗经历快感缺失和相关奖励系统功能障碍的青少年的一种特别有效的干预措施。在本研究中,快感缺失的青少年(AA;n = 39)接受了 12 周的 BA 治疗,并在治疗前和治疗后(以及每周的快感缺失自我报告评估)进行了多模态(即神经、行为和自我报告[生态瞬时评估])奖励功能评估。正常发展的青少年(TDA;n = 41)在相应的时间点完成了相同的测量。多层次模型测试了治疗前与快感缺失改善相关的奖励相关预测因素,以及 BA 过程中奖励措施的变化。分析显示,BA 治疗后快感缺失显著减少。增强的治疗前神经(纹状体)奖励反应性预测了更大的快感缺失改善。相比之下,基线自我报告和行为奖励测量不能预测治疗结果。组间时间交互作用显示,AA 青少年的奖励和损失相关神经反应性都有更大的增加。与资本化为模型一致,治疗前神经 - 而不是自我报告或行为 - 相对增强奖励反应性的测量预测了更好的 BA 结果。除了缓解快感缺失,成功的 BA 还可能增加快感缺失青少年对情感相关(例如,奖励和损失相关)刺激的神经敏感性。

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